Am J Epidemiol. Am J Public Health Nations Health. FOIA Share cases and questions with Physicians on Medscape consult. Murray CK, Hospenthal DR. 1993 Jan. 12(1):48-54. Leptospira canicola usually presents as an aseptic meningitis. [QxMD MEDLINE Link]. Climate change and vector-borne diseases: a regional analysis. [QxMD MEDLINE Link]. Socolovschi C, Angelakis E, Renvois A, Fournier PE, Mari JL, Davoust B, et al. Smith S, Liu Y-H, Carter A, et al. Learn the symptoms of monkeypox infection, how it is transmitted, and the steps you can take to prevent infection. 15. How you get leptospirosis Leptospirosis is spread in the pee of infected animals, most commonly rats, mice, cows, pigs and dogs. Clin Microbiol Rev. JAMA. [17]. Takafuji ET, Kirkpatrick JW, Miller RN, Karwacki JJ, Kelley PW, Gray MR, et al. Gastroenterology and Hepatology, State University of New York Downstate Medical Center, Brooklyn, USA. Glucocorticoids in leptospira alveolar hemorrhage. Leptospirosis, also called Weil's disease, is an infection you can get from animals, soil or water. Healthline Media does not provide medical advice, diagnosis, or treatment. Fever? It is considered the most common zoonosis in the world and is associated with settings of poor sanitation and agricultural occupations involving contact with animals or water. We report a case of leptospirosis presenting with gastrointestinal symptoms and abnormalities in liver function tests. Spichler A, Athanazio D, Seguro, AC, et al. [QxMD MEDLINE Link]. 2012 Feb 15. [Immunomodulation in severe leptospirosis with multiple organ failure: plasma exchange, intravenous immunoglobulin or corticosteroids?]. Leptospirosis in Hawaii, USA, 1999-2008. Update: leptospirosis and unexplained acute febrile illness among athletes participating in triathlons--Illinois and Wisconsin, 1998. On microscopic evaluation, severe damage was seen in zone 3 (centrilobular region) with evidence of submassive necrosis of hepatocytes and remarkable hemorrhage. [QxMD MEDLINE Link]. Centers for Disease Control and Prevention. (This image is in the public domain and thus free of any copyright restrictions. [QxMD MEDLINE Link]. Wien Klin Wochenschr. You are being redirected to The incidence varies from sporadic in temperate zones to endemic in a few tropical countries. Haake DA, et al. [QxMD MEDLINE Link]. If youve been diagnosed with leptospirosis, keep an eye on your symptoms. cookies so that we can recognise you and provide you with the best service. 2011 Feb. 17(2):221-6. Person DA. [Full Text]. Other problems to be considered may include the following: Palaniappan RU, Ramanujam S, Chang YF. Shigellosis is a bacterial infection that affects the digestive system. Placebo-controlled trial of intravenous penicillin for severe and late leptospirosis. Dall'Antonia M, Sluga G, Whitfield S, Teall A, Wilson P, Krah D. Leptospirosis pulmonary haemorrhage: a diagnostic challenge. Leptospirosis in Taiwan--an underestimated infectious disease. Patients may also experience stomach discomfort, red-eye, and possible skin rash. It develops when you come into contact with: The bacteria can enter the body through open wounds or mucous membranes, like the eyes or mouth. [QxMD MEDLINE Link]. Humans are not typically considered reservoirs but may chronically shed leptospires and may act as reservoirs in areas of high endemicity and poor waste sanitiation. Watt G, Padre LP, Tuazon ML, Calubaquib C, Santiago E, Ranoa CP, et al. In an autopsy series of fatal cases of leptospirosis in Mumbai, India in 2005, involvement of the cardiovascular system was found in 41 of 44 cases. Ann Fr Anesth Reanim. [QxMD MEDLINE Link]. [22] Within these species, leptospires are further grouped by serogroups, serovars, and strains on the basis of microscopic agglutination testing (MAT). Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. You can get infected through: You can get leptospirosis no matter where you live, but its most common in tropical areas and warmer climates with lots of rainfall each year. [QxMD MEDLINE Link]. In most cases, leptospirosis is unpleasant but not life-threatening, like a case of the flu. If the host survives the acute infection, septicemia and multiplication of the organism persist until the development of opsonizing immunoglobulin in the plasma, followed by rapid immune clearance. for: Medscape. An efficacy trial of doxycycline chemoprophylaxis against leptospirosis. Sandra G Gompf, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of AmericaDisclosure: Nothing to disclose. Leptospiruria in humans is more transient, rarely lasting more than 60 days. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Prophylaxis may be used in the setting of epidemics. Routine laboratory tests showed thrombocytopenia (platelets: 48,000/uL), with normal hemoglobin and white blood cell counts. Leptospirosis can have serious life threatening effects. Int J Clin Pract. But, you may have to go to the hospital if your infection is more severe. Keep your pets out of contaminated water, especially after heavy rainfall or flooding. Dengue, in particular, and chikungunya often overlap in territory with leptospirosis, and more than one infection may be present. In the majority of cases, leptospirosis causes a mild illness but, in some people, a more severe form of leptospirosis occurs. Determination of susceptibilities of 26 Leptospira sp. World Health Organization. Many strains have been isolated from . Blood tests will show signs of infection. A timely workup and early initiation of antibiotics are the mainstays of management. Shenoy VV, Nagar VS, Chowdhury AA, Bhalgat PS, Juvale NI. JAMA. Chierakul W, Tientadakul P, Suputtamongkol Y, Wuthiekanun V, Phimda K, Limpaiboon R, et al. Cochrane Database Syst Rev. Malani J, Pryor J, Lusangulira K. Leptospirosis in Pohnpei (1986-1995): a case series on the use of dopamine/steroid for Weil's syndrome. [QxMD MEDLINE Link]. 1998 Nov. 178(5):1457-63. Drinking only treated water. Medical Surveillance Monthly Report. Leptospirosis, as a clinical entity, is underdiagnosed and underreported. Medscape Education, Immunization Against Dengue: The Accumulated Clinical Trial Data, encoded search term (Leptospirosis) and Leptospirosis, Headache? Specific serovars vary with locality. Annually, seven to ten million people get leptospirosis. Worse outcomes have been seen, especially if combined with acute renal failure. J Fam Pract. and transmitted securely. AST, aspartate aminotransferase; ALT, alanine aminotransferase; INR, international normalized ratio. Medical Surveillance Monthly Report. 2011 Nov. 128(5):275-7. 104(4):259-64. Vilaichone RK, Mahachai V, Wilde H. Weils disease (leptospirosis) manifesting as fulminant hepatic failure: report of an autopsy case. 6(2):75-9. Southeast Asian J Trop Med Public Health. Meningitis in the Returning Traveler. [QxMD MEDLINE Link]. This is most. Silver stain, liver, fatal human leptospirosis. 2008 Mar. 47(32):673-6. Smith S, Liu Y-H, Carter A, et al. Other signs that you should contact a doctor include: Your healthcare team can diagnose leptospirosis using the following methods: The best way to prevent leptospirosis is to avoid exposure to the bacteria. The case fatality rate for leptospirosis is approximately 5%-15% among patients with severe illness. CDC. 2019 December 02. What is leptospirosis? [QxMD MEDLINE Link]. [13]. 1963 Jun. Its less common than the first phase of leptospirosis. 2007 Feb. 11(1):142-8. Dursun B, Bostan F, Artac M, Varan HI, Suleymanlar G. Severe pulmonary haemorrhage accompanying hepatorenal failure in fulminant leptospirosis. Women who are pregnant or who are trying to become pregnant should avoid exposure to leptospirosis or may consider avoiding pregnancy during periods of high-risk exposure. In severe cases of leptospirosis, you have symptoms of internal bleeding and organ damage. [23]. Clin Infect Dis. Its unclear what type of illness Madonna was diagnosed with. It's caused by Leptospira bacteria. 20(3):284-92. Leptospirosis in humans. PMCID: PMC7336590 DOI: 10.7759/cureus.8428 Abstract Weil's disease is a complication of untreated leptospirosis and can be fatal. Despite the appropriate management, the very low . The clinical presentation can be non-specific and easily confused with other viral diseases, such as dengue. Radl C, Mller M, Revilla-Fernandez S, Karner-Zuser S, de Martin A, Schauer U, et al. But it can also lead to serious complications, such as meningitis, and it can be fatal. Leptospirosis ranges in severity from no symptoms to a mild illness suggesting a viral infection to a multisystemic syndrome with unique features. Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London This cosmopolitan disease is due to pathogenic agents of Leptospira interrogans species ( 2, 3 ). The current classification system is based on DNA homology and recognizes the heterogeneity of the classic leptospires, dividing L interrogans and L biflexa into 20 named species. The symptoms range from mild or asymptomatic to severe fatal illness. 78(9):1136-47. Epidemiology and characterization of leptospirosis at an urban and provincial site in Thailand. Hemorrhage, focal necrosis, and inflammatory infiltration have been documented within the adrenal gland. You may have mild symptoms or no symptoms in the leptospiremic phase. Silver stain, liver, fatal human leptospirosis. Last edited 11/2022 and last reviewed 02/2023. [Full Text]. [Full Text]. The high incidence of Weil's disease among coalminers confirms the experi- ence of earlier workers (Buchanan 1924, 1927, Alston and Brown 1935). Based on this system, the genus Leptospira contains two species: the pathogenic Leptospira interrogans, with at least 218 serovars; and the nonpathogenic, free-living, saprophytic Leptospira biflexa, which has at least 60 serovars. Empirical antibiotic treatment was applied (ampicillin/sulbactam 3 g tid, azithromycin 500 mg qd, metronidazole 500 mg tid) with addition of methylprednisolone 40 mg tid and . 2008 Jan 15. The nomenclature system used to organize leptospires has been revised, making review of the literature often confusing. Emerg Infect Dis. CDC. [QxMD MEDLINE Link]. Leptospirosis during pregnancy can cause fetal complications including fetal death or abortion. If youre around soil or water where an infected animal has peed, the germ can invade your body through breaks in your skin, like scratches, open wounds, or dry areas. [QxMD MEDLINE Link]. CDC. Most cases occur during the rainy season in the tropics and during the late summer or early fall in Western countries, as leptospires survive best in fresh water, damp alkaline soil, vegetation, and mud with temperatures higher than 22C. Treatment can help reduce the severity of leptospirosis. 2001 Apr. [QxMD MEDLINE Link]. Vaccination is repeated yearly. MMWR Morb Mortal Wkly Rep. 1998 Aug 21. 3:153-61. Hepatic and renal functions return to normal, despite severe dysfunction during acute illness, even among patients who required dialysis. Its rare for leptospirosis to spread between humans. It is commonly seen in sewage workers, farmers andhunters and is associated with outdoor activities such as kayaking, rafting and tramping [4]. Pacific Health Dialog. This is a type of bacterial infection. The symptoms of leptospirosis range in type and severity. High dose corticosteroids in severe leptospirosis: a systematic review. However, experts say this human-to-animal. Avoid touching or swimming in floodwater. In the immune phase, Leptospira bacteria has moved from your blood to your organs. Liver involvement is marked by centrilobular necrosis and Kupffer cell proliferation. 19(2):317-22. [QxMD MEDLINE Link]. Wearing protective shoes and clothing if you have to be in contact with water or soil that might be contaminated with bacteria. Avoid contact with environments potentially contaminated with animal urine, especially rodent-infested areas. These authors suggested that leptospirosis be viewed as an infective systemic vasculitis. Complete disappearance of CD-31-positive, sinusoidal endothelial cells confirmed endothelial damage in zone 3 as the direct cause of fulminant hepatic failure, while zones 1 and 2 remained unaffected. Other routine types of contact and care pose little risk. Get useful, helpful and relevant health + wellness information. When Did Medicine Become a Battleground for Everything? [QxMD MEDLINE Link]. nov. and Leptospira yanagawae sp. Although direct invasion of tissue may cause some pathologic effects, researchers note that the marked degree of multiorgan tissue injury appears inconsistent with the number of leptospires found on microscopic examination of tissue. Copyright contained herein is strictly prohibited. 2004 Oct. 48(10):4002-5. At-risk animals are those that frequent areas where there are cattle, swine, rodents, or wild animals or that may drink from lakes, rivers, or streams in rural areas. L interrogans included more than 250 serovars. Recognition of a diagnosis of acute liver failure,despite the absence of encephalopathy in these cases, with appropriate referrals to transplant centersmay be life-saving. Awareness of leptospirosis and its hepatic manifestations are limited. This complication is considered to be the major cause of leptospirosis-associated death. [QxMD MEDLINE Link]. Shintaku M, Itoh H, Tsutsumi Y. Liver transplantation for acute liver failure attributed to leptospirosis: a report of two cases. 2011 Dec. 4(12):1007-8. If youre in a developing country, dont drink the water unless youre sure its clean. Courtesy of the Centers for Disease Control and Prevention (CDC), Rob Weyant. [10]. All rights reserved. Outbreak of acute febrile illness and pulmonary hemorrhage--Nicaragua, 1995. They are unique among the spirochetes in that they can be isolated on artificial media. 2001 Sep. 49:901-3. Leptospirosis is an illness caused by an infection with the bacteria Leptospira. 1 Bull World Health Organ. The maximum bilirubin value noted was 65.9mg/dL with an INR of 6.76. It ends up in soil and water through their urine. Accessed: April 24, 2014. 81 (1):107-110. COVID-19 may follow a similar trajectory and may complicate diagnosisin the subtropics and tropics. In 2013, leptospirosis was reinstated as a nationally notifiable disease. Bethesda, MD 20894, Web Policies Laboratory studies used to screen for the diagnosis of leptospirosis include the following: Laboratory studies used to confirm the diagnosis of leptospirosis include the following: Studies to determine the extent of organ involvement and severity of complications may include the following, depending on the clinical presentation: Antibiotic therapy in the treatment of mild leptospirosis is typically unnecessary, since it is often self-limited, and most cases resolve without medical attention. coughing. [QxMD MEDLINE Link]. 2007 Jan. 12(1):111-22. You can get leptospirosis from: A lot of people can get leptospirosis at once (an outbreak) after heavy rains and flooding. [18]. 56(3):197-203. CDC. 2011 Dec. 123(23-24):751-5. The site is secure. JAMA. [QxMD MEDLINE Link]. https://www.cdc.gov/leptospirosis/features/adventure-racing.html, http://whqlibdoc.who.int/hq/2003/WHO_CDS_CSR_EPH_2002.23.pdf, Southern Society for Clinical Investigation, American College of Occupational and Environmental Medicine, American College of Physicians-American Society of Internal Medicine, American Society of Tropical Medicine and Hygiene, Alliance for the Prudent Use of Antibiotics, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, Association for Professionals in Infection Control and Epidemiology, Infectious Disease Society for Obstetrics and Gynecology, Southwestern Association of Clinical Microbiology. Yes, you can survive leptospirosis. Rats and other rodents are the main carriers of the bacteria. 78(9):1136-47. April 17, 2015; Accessed: June 13, 2018. 104(4):259-64. Have your pet pee away from bodies of water or places people will touch, like benches. Most deaths occur from renal failure, massive hemorrhage, or acute respiratory distress syndrome (ARDS). [QxMD MEDLINE Link]. Leptospirosis is an infectious disease of humans and animals that is caused by pathogenic spirochetes of the genus Leptospira. Leptospira canicola usually presents as an aseptic meningitis. Outbreak of leptospirosis in new caledonia: diagnosis issues and burden of disease. Jaundice may occur as a result of hepatocellular dysfunction. From 1985-1994, the reported annual incidence ranged from 0.02-0.04 cases per 100,000 persons. Radl C, Mller M, Revilla-Fernandez S, Karner-Zuser S, de Martin A, Schauer U, et al. Prospective study of leptospirosis transmission in an urban slum community: role of poor environment in repeated exposures to the Leptospira agent. nov., respectively. In 90% of cases, leptospirosis manifests as an acute febrile illness with a biphasic course and an excellent prognosis. Leptospira species infect a wide range of animals, including mammals, birds, amphibians, and reptiles. The commonest form, also called Weil's disease, is caused by Leptospira icterohaemorrhagiae. These spirochetes are finely coiled, thin, motile, obligate, slow-growing aerobes. [Full Text]. However, because occupational exposure constitutes a major risk for development of disease, a disproportionate number of working-aged males seem to be affected. Leptospirosis. [QxMD MEDLINE Link]. In the kidneys, leptospires migrate to the interstitium, renal tubules, and tubular lumen, causing interstitial nephritis and tubular necrosis. Chakurkar G, Vaideeswar P, Pandit SP, Divate SA. [QxMD MEDLINE Link]. Chang Gung Med J. 2003 May-Jun. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Renal failure is usually due to tubular damage, but hypovolemia from dehydration and from altered capillary permeability can also contribute to renal failure. In uncomplicated infections that do not require hospitalization, oral doxycycline has been shown to decrease duration of fever and most symptoms. Courtesy of the Centers for Disease Control and Prevention (CDC), Dr Martin Hicklin. The skin is affected by epithelial vascular insult. Severe leptospirosis in tropical Australia: Optimising intensive care unit management to reduce mortality. 1996. Epidemiology of leptospirosis. [QxMD MEDLINE Link]. nov., Leptospira terpstrae sp. [Full Text]. Contact with the organism via infected urine or urine-contaminated media results in human infection. 2007 Aug. 61(8):441-7. Give your pet the prescription antibiotics, as instructed by your veterinarian. 1992 Apr. 47(32):673-6. Transmission most commonly occurs from animal urine and through contact with freshwater bodies. J Infect Dis. But are bacterial infections, Bacterial infections are common causes of gastroenteritis. Weils syndrome is often deadly if not treated or if you delay treatment. [QxMD MEDLINE Link]. Mayxay M, Sengvilaipaseuth O, Chanthongthip A, et al. As stated, Weil's Disease is caused by a bacterial infection caused by leptospira bacteria. [QxMD MEDLINE Link]. Am J Public Health Nations Health. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. Washington, DC: The National Academies Press; 2010. Keep your pets away from rodents, wild animals, and animal carcasses. High-risk areas include the Caribbean islands, Central and South America, Southeast Asia, and the Pacific islands. Pappachan JM, Mathew S, Thomas B, Renjini K, Scaria CK, Shukla J. Be careful if you have to handle wild rats or come in contact with their habitats. Peter G, Narasimha H. Acalculous cholecystitis: a rare presentation of leptospirosis progressing to Weil's disease. Your healthcare provider will still keep a close eye on your symptoms. Trevejo RT, Rigau-Prez JG, Ashford DA, McClure EM, Jarqun-Gonzlez C, Amador JJ, et al. Courtesy of the Centers for Disease Control and Prevention (CDC), Dr Martin Hicklin. Well also discuss the best ways to prevent the condition in both people and pets. Trans R Soc Trop Med Hyg. Widespread flooding may lead to epidemic spread of leptospirosis in large populations. Elder Abuse: Warning Signs to Watch Out for During Care, Experts Decry CDC's Long Pause on Neglected Tropical Disease Testing, Clinical Trial Begins for New Drug to Combat Neglected Tropical Diseases. Classification of Leptospira genomospecies 1, 3, 4 and 5 as Leptospira alstonii sp. ICG-PDR is an easy-to-use, quick and non-invasive tool that can be utilized to predictICU admission in resource-limited endemic regions. So, recognize the symptoms and seek help if you become ill. Use disinfectant. Avoid swimming in freshwater, like rivers or streams, that might contain animal urine. [QxMD MEDLINE Link]. [Full Text]. Identify and assess: The risk of Weil's disease is linked to areas where rats are or have been present. Inada et al identified the causal agent of infectious jaundice in Japan in 1916, naming the organism Spirochaeta icterohaemorrhagiae. Explore lung, breathing and allergy disorders, treatments, tests and prevention services provided by the Cleveland Clinic Respiratory Institute. nov. and Leptospira yanagawae sp. for: Medscape. Sometimes, leptospirosis causes mild flu-like symptoms or no symptoms at all. Approximately a third of patients with documented aseptic meningitis may continue to complain of periodic headaches of varying severities. Policy. [QxMD MEDLINE Link]. 1998 Jun. Virulent organisms in a susceptible host gain rapid access to the bloodstream through the lymphatics, resulting in leptospiremia and spread to all organs, but particularly the liver and kidney. 2001 Apr. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. Denise Demers, MD, FAAP Assistant Professor of Pediatrics, Uniformed Services University of the Health Sciences; Attending Physician, Division of Pediatric Infectious Diseases, Department of Pediatrics, Tripler Army Medical Center, Juan D Diaz, DO Fellow in Infectious Diseases, University of South Florida College of Medicine, Tampa General Hospital, and James A Haley Veterans Hospital, Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University, Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa, Patrick W Hickey, MD, FAAP Assistant Professor of Pediatrics and Preventive Medicine, Uniformed Services University of the Health Sciences; Consulting Staff, Department of Pediatrics, Division of Pediatric Infectious Disease, Walter Reed Army Medical Center, Patrick W Hickey, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine, and Pediatric Infectious Diseases Society, Edmond A Hooker II, MD, DrPH, FAAEM Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine; Associate Professor, Department of Health Services Administration, Xavier University, Edmond A Hooker II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, and Southern Medical Association, Matthew R Jezior, MD Fellow, Department of Cardiology, Walter Reed Medical Center, Maria D Mileno, MD Associate Professor of Medicine, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Maria D Mileno, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine, and Sigma Xi, Joseph T Morris, MD Chief of Infectious Disease Service, Madigan Army Medical Center; Assistant Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences, Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital, Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society, Cecily K Peterson, MD Program Director, Clinical Faculty, Department of Medicine, Madigan Army Medical Center, Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center, Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, AmericanGeriatricsSociety, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, InfectiousDiseases Societyof America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology, William H Shoff, MD, DTM&H Director, PENN Travel Medicine; Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society, Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine, Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association, Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference, Jeter (Jay) Pritchard Taylor III, MD Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist, Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine, Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference.
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